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Resume Introduction La section des nerfs alveolaires superieurs lors de l’osteotomie de Le Fort I entraine habituellement une perte de la sensibilite des dents maxillaires. Le but de notre etude a ete d’analyser la cinetique de recuperation de la sensibilite dentaire postoperatoire. Materiel et methode Une etude prospective a ete menee chez des patients operes pour osteotomie de Le Fort I isolee, associee a une osteotomie mandibulaire ou a une disjonction intermaxillaire (DIM). Les mouvements effectues au cours de l’intervention ont ete notes. Une dent par secteur alveolaire (incisivo-canin, premolaire, molaire, au mieux) a ete testee pour chaque patient a l’aide d’un testeur electrique. Les tests ont ete effectues en preoperatoire (j1), a j2, j15, M2 (+2 mois), M3 et M6 postoperatoires. Resultats Vingt-deux patients ont ete inclus. A j1, 91,9 % des dents testees etaient sensibles, a j2, 12,7 % des dents etaient sensibles. A j15, M2, M3 et M6, les pourcentages de dents sensibles etaient respectivement de 33,3 %, 43,1 %, 50 % et 61,8 %. La recuperation sensitive a ete significativement plus rapide et plus complete chez les patients âges de moins de 35 ans et au niveau des dents situees dans le territoire des nerfs alveolaires superieur et moyen. Il n’a pas ete note de difference significative en fonction des mouvements effectues. Discussion Parmi les dents sensibles a j1, 87,3 % ne l’etaient plus a j2. La recuperation sensitive des dents atteintes s’effectue des j15. Une grande amplitude de mouvement semble etre un facteur aggravant.

Summary Introduction A palatal defect with bucconasal fistula often follows exeresis of palatal tumors. It cannot be directly sutured. Several techniques have been used to cure such defects: palatal obturator, free, or local flaps. Technical note The tongue pediculated flap is an easy, safe, and reliable surgical option to reconstruct palatal defects. The tongue flap is a double-layer muscular and mucosal flap that requires two surgeries. During the first, the flap is harvested on the tongue and partially sutured on the anterior portion of the palatal defect. During the second, the pedicle is freed from the tongue and sutured to the posterior portion of the palatal defect. Between these two surgeries the patient is fed through a nasogastric tube. Discussion The tongue flap is easy and reproducible. It can be recommended in mediopalatal defects after cancer palatal surgery. Its esthetical and functional results are excellent. It is an alternative to palatal obturator, which are not well tolerated in the long run. Similar but uneven results are obtained with free flaps. Free flaps do not require a second surgery but are more difficult to implement in developing countries.

Summary Introduction Digital photography is more and more important in our everyday medical practice. Patient data, medico-legal proof, remote diagnosis, forums, and medical publications are some of the applications of digital photography in medical and dental fields. A lot of small, light, and cheap cameras are on the market. The main issue is to obtain good, reproducible, cheap, and easy-to-shoot pictures. Technical note Every medical situation, portrait in esthetic surgery, skin photography in dermatology, X-ray pictures or intra-oral pictures, for example, has its own requirements. For these reasons, we have tried to find an “ideal” compact digital camera. The Sony DSC-T90 (and its T900 counterpart with a wider screen) seems a good choice. Its small size makes it usable in every situation and its price is low. An external light source and a free photo software (XnView ® ) can be useful complementary tools. The main adjustments and expected results are discussed.

Resume Introduction Les publications sur les recidives des dysmorphoses maxillomandibulaires avec beance anterieure exposent des resultats bruts sans proposition therapeutique. Les techniques d’osteotomie sont comparees sans chercher de facteurs de recidive, qu’ils soient dysfonctionnels et/ou architecturaux. Nous avons etudie la valeur predictive du plan d’occlusion dans les recidives a long terme des beances anterieures. Materiel et methode Cinquante patients ont ete inclus entre 1996 et 2007. L’angulation postoperatoire immediate du plan d’occlusion a ete comparee a l’angulation du plan d’occlusion « ideal » de Delaire et l’ensemble des recidives ont ete repertoriees grâce aux radiographies a distance (superieures a 12 mois). Les patients ont ete separes en deux groupes : ceux dont le plan d’occlusion postoperatoire etait a plus ou moins 3,75° par rapport au plan « ideal », et ceux dont l’angulation depassait ces limites. Resultats Les recidives etaient sept fois plus frequentes lorsque le plan d’occlusion postoperatoire deviait de plus ou moins 3,75° par rapport au plan « ideal ». Discussion L’angulation du plan d’occlusion postoperatoire est un facteur predictif de recidives des beances anterieures.

Resume Introduction Les lithiases du canal de Wharton siegent plus souvent au niveau du tiers posterieur du canal. Leur traitement classique etait la submandibulectomie. L’exerese endobuccale par « taille » est une alternative a la submandibulectomie, conservatrice et recommandable. C’est ce que nous avons voulu demontrer a travers cette etude prospective. Patients et methode L’indication operatoire a ete posee apres verification du caractere palpable de la lithiase et confirmee par un scanner sans injection. Les calculs ont ete enleves par voie buccale sous anesthesie generale, puis la vacuite des canaux salivaires a ete controlee par sialendoscopie. Trente-six patients ont ete suivis de facon prospective, en moyenne pendant six mois (entre un et 36 mois). Resultats Chez 34 patients l’abord endobuccal a permis d’extraire la lithiase sans aucune complication neurologique definitive. Nous avons eu deux echecs sur des calculs non palpables et deux recidives lithiasiques, correspondant a de petits calculs intraglandulaires, elimines secondairement. Discussion L’abord endobuccal des lithiases posterieures du canal de Wharton est une technique sure, reproductible qui genere moins de complications que la submandibulectomie. Elle doit donc etre recommandee dans les calculs palpables du tiers posterieur du canal submandibulaire.

Contexte : L’existence de nombreux protocoles d’hemostase pour les avulsions dentaires chez les patients adultes ayant un deficit en facteur de l’hemostase(FH) a conduit le Service de Stomatologie et de Chirurgie Maxillo-faciale et le Centre de Traitement des Hemophiles du Groupe hospitalier Cochin-Saint-Vincent-de-Paul-La-Roche-Guyon(Paris) a proposer des recommandations pour leur prise en charge. Objectif : Etablir des recommandations pour les avulsions dentaires et les kystectomies chez les patients atteints d’un deficit congenital (mineur, modere ou severe) en FH revient a definir le protocole d’hemostase visant a reduire le recours aux concentres de facteurs de l’hemostase (CFH), tout en assurant la securite et le confort pour le patient. Methodologie : La methodologie d’elaboration des recommandations repose sur une revue et une analyse critique des donnees de la litterature scientifique par un Groupe de travail permettant de definir, sur la base du niveau de preuves scientifiques (NdP 1-2-3-4) et du jugement argumente du groupe de travail, des recommandations(Grades A-B-C). Les recommandations ainsi elaborees sont validees par un groupe de lecture independant. Materiel : Les donnees sources pour l’elaboration des recommandations sont issues : 1) d’une recherche automatisee sur la banque de donnees Medline couvrant la periode 1966-2003 ; 2) d’une recherche manuelle dans les quintessences des 23 et 24e congres de la World Federation of Hemophilia (WFH) ; 3) la lecture de six ouvrages francais et anglais de pathologie et de chirurgie buccales. Resultats : La lecture de 279 articles, de 13 resumes de congres et de 6 ouvrages ont permis d’etablir les recommandations generales suivantes : 1) approche pluridisciplinaire associant un hematologue et un stomatologiste ou un odontologiste ; 2) protocole d’hemostase adapte au type et a la severite du deficit en FH, ou au type de chirurgie – dent(s) sur l’arcade, dent(s) incluse(s), avulsions multiples… – tout en tenant compte de la compliance du patient (criteres DCP). Les recommandations sont presentees selon la chronologie des differents phases operatoires. En pre-operatoire : 1) prescription d’acide tranexamique et d’antibiotiques; 2.a) pour les patients ayant un deficit severe avec ou sans inhibiteur ou pour des avulsions sous anesthesie generale : perfusion quasi systematique du FH manquant dans l’heure precedant l’intervention : facteur VIII pour l’hemophilie A, facteur IX pour l’hemophilie B, facteur Willebrand pour la maladie de Willebrand de type 3; 2.b) pour les patients ayant un deficit modere ou mineur : administration de desmopressine (meme si la reponse est partielle) pour l’hemophilie A et la maladie de Willebrand, sans administration systematique de FH. En per-operatoire : 1) privilegier l'anesthesie locale faite avec un anesthesique a liaison amide associe a un vasoconstricteur; 2) avulsions multiples realisees en plusieurs seances, en general par hemi-arcade; 3) avulsion ou kystectomie la moins delabrante possible, completee par un parage minutieux de la plaie; 4) lambeaux strictement muco-periostes; 5) pour realiser l’hemostase locale on associe suture et/ou colle chirurgicale avec un materiau tels que des meches d'oxycellulose; 6) pour completer l’hemostase locale, mise en place de gouttieres hemostatiques; 7) anesthesie generale pour les actes de chirurgie invasive (dents incluses en position ectopique, avulsions multiples touchant les diff e rents quadrants, edentation totale bimaxillaire, kystectomie) sous reserve d’une correction prealable du deficit en FH par un traitement substitutif. En post-operatoire : 1) perfusion(s) de CFH et/ou de desmopressine a la demande en cas de saignement ou a l’appreciation du chirurgien et de l’hematologue; 2) prescription d’un antalgique et d’acide tranexamique; 3) remise au patient d’une fiche de conseils post operatoires comportant un numero de telephone repondant 24 h/24 aux appels d’urgence; 4) consultation a J7.

Aim: Fibular bone grafts are considered as one of the best choices for reconstruction of the condyle. However, little data are available on bone remodelling after such reconstruction. The purpose of this study was to evaluate the long-term radiological outcome . Patients and Methods: Eleven patients underwent condylar reconstruction with a free fibular transplant. In all cases the end of the fibular graft was placed into the glenoid fossa under the intact temporomandibular joint (TMJ) disc. Evaluation consisted of digital width and length measurement of the end of the fibula on panorex studies . Results: Remodelling of the end of the neocondyle was found and consisted of rounding off and narrowing of the end of the transplant . Conclusion: The most likely explanation for these changes is the fact that the TMJ disc was preserved .

Summary Introduction Osteopetrosis is a metabolic bone disease that leads to bone malformation and bone healing disorders. We report the case of a patient who underwent orthognathic surgery to treat a class III skeletal malocclusion. Observation A 21-year-old patient had presented with osteopetrosis in his childhood, which had been treated by bone marrow transplantation. He presented with esthetic and functional sequels, a class III skeletal malocclusion, lateral mandibular deviation, and dental agenesis. This dysmorphism was corrected by bimaxillar osteotomy. The postoperative outcome was uneventful, with satisfactory and stable healing. Discussion The patient's lesions where after-effects of his disease, but the bone structure is normal, because osteopetrosis regressed after bone marrow transplantation. There is no risk for the consolidation. Osteopetrosis, even when treated by bone marrow transplantation, is not a contraindication for maxillomandibular osteotomy.

Vascularized free flaps are now considered the most appropriate choice for mandible reconstruction because they offer excellent cosmetic and functional results. Various techniques have been proposed. Free fibular flaps have numerous advantages in terms of versatility and contouring. Shaping can be achieved by wedge osteotomy with excellent results. However, this technique leads to bone loss and may be difficult in the later stages of the procedure. The purpose of this report is to describe a simple and safe flap-shaping method involving axial split osteotomy.

Recurrence is a major problem after release of temporomandibular joint ankylosis. Early physiotherapy and choice of interpositional material are important in preventing recurrence. Currently, the most used technique is gap arthroplasty associated with coronoidectomy, temporalis muscle flap interposition and reconstruction of the condylar unit with a costochondral graft. Full-thickness skin graft interposition, using the technique described by Popescu & Vasiliu, can also be used. This retrospective review of 31 patients confirms the reliability of full-thickness skin graft interposition. Results were successful in 90% of the 20 patients with follow-up longer than one year.

A variety of interposition materials have been used to prevent recurrence after arthroplasty in treatment of temporomandibular joint ankylosis. The purpose of this retrospective study of our experience was to compare the different materials (skin, temporal muscle, homologous cartilage) used for interposition arthroplasty over a period of 22 years. A total of 25 patients (32 joints) with at least 3 years of follow-up were included. Good results were achieved in 92% of cases using total full thickness skin graft and 83% of cases using temporal muscle flap. Homologous cartilage gave poor results.

Objective The classic technique for open reduction of subcondylar fracture is the submandibular approach. The aim of this study was to evaluate long-term clinical and radiologic results of the short retromandibular approach to displaced subcondylar fractures. Material/Methods During a period of 66 months we performed a prospective study with a modified version of the retromandibular approach in 38 patients with displaced subcondylar fractures. In this article we describe clinical and radiologic results in 19 patients with follow-ups longer than 6 months (range, 6 to 66 months). Preoperatively all patients had malocclusion and radiology demonstrated displacement. Results The retromandibular surgical approach was successful in all cases. Roughly 25 months after surgery, mouth opening was 43 mm with symmetric laterotrusive movements. Permanent marginal nerve palsy was never observed. Conclusions Our findings indicate that the short retromandibular approach is an easy and safe technique for displaced subcondylar fractures.

Lingual nerve damage is one of the most common complications of lower third molar removal. However evaluation of the factor involved in these lesions is difficult since most previous series are heterogeneous. The purpose of this prospective randomized study was to ascertain the impact of lingual nerve protection in a homogeneous series including only patients undergoing third molar germectomy (i.e. removal of the developmental bud prior to anchoring of the roots in the jaw). Data from a total of 300 germectomy procedures were included in this study. All procedures were performed by the same experienced surgeon randomly with or without lingual nerve protection. No lingual nerve injury was observed after third molar germectomy regardless of whether or not lingual nerve protection was used. Lingual nerve protection is unnecessary for lower third molar germectomy.

Posterior disk displacement is a rare temporomandibular joint (TMJ) disorder. The main clinical sign is sudden molar open-bite (jaw locked in the open position). This may be accompanied by a sensation of intra-articular foreign body and more rarely joint pain. Joint sounds are unremarkable. Mouth opening may be slightly impaired. Hypothetically, like anterior disk displacements, posterior disk displacements can be classified as either reducible or nonreducible. A definitive diagnosis requires magnetic resonance imaging (MRI). There is no consensus concerning treatment. A conservative course of treatment can be successful in patients with functional impairment and should always be attempted before irreversible, invasive therapy.

Thirty-four therapeutic temporomandibular arthroscopies were done during a 24-month period for patients with debilitating joint disorders (mainly disc displacements with or without reduction) who had not responded to non-invasive treatment. Lysis and lavage with prediscal section and retrodiscal coagulation were the techniques used. Analysis of the results indicated subjective improvement of pain in 71% of cases, noise in 78%, jaw opening in 88% and diet in 97% and objective evidence of disappearance of noise in 29% and improvement of jaw opening in 94% (mean 9.24 mm). In jaw opening, improvement was highly significant, compared with the preoperative results, P < 0.01. We conclude that temporomandibular arthroscopy is safe and indicated in disc displacements and joint luxation if medical treatment has failed.